Author + information
- Doo Sun Sim1,
- Myung-Ho Jeong1,
- Youngkeun Ahn1,
- Young Jo Kim2,
- Shung Chull Chae3,
- Taek Jong Hong4,
- In-Whan Seong5,
- Jei Keon Chae6,
- Chong-Jin Kim7,
- Myeong-Chan Cho8,
- Seung-Woon Rha9,
- Jang-Ho Bae10,
- Ki-Bae Seung11 and
- Seung-Jung Park12
- 1Chonnam National University Hospital, Korea (Republic of)
- 2Yeungnam University Medical Center, Korea (Republic of)
- 3Kyungpook National University Hospital, Korea (Republic of)
- 4Pusan National University Hospital, Korea (Republic of)
- 5Chungnam National University Hospital, Korea (Republic of)
- 6Chonbuk National University Hospital, Korea (Republic of)
- 7Kyung Hee University Hospital at Gangdong, Korea (Republic of)
- 8Chungbuk National University Hospital, Korea (Republic of)
- 9Korea University Guro Hospital, Korea (Republic of)
- 10Konyang University Hospital, Korea (Republic of)
- 11The Catholic University of Korea, Seoul St. Mary’s Hospital, Korea (Republic of)
- 12Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of)
The optimal timing of intervention in Non-ST-elevation myocardial infarction (NSTEMI) remains controversial. We sought to assess an impact of the immediate percutaneous coronary intervention (PCI) and optimal PCI timing for stable NSTEMI.
A total of 6,134 NSTEMI patients undergoing PCI from the Korea Acute Myocardial Infarction Registry were divided into group 1 (immediate PCI within 4 hours, n = 1,132) and group 2 (deferred PCI after 4 hours, n=5,002). Patients with recurrent or refractory ischemia, systolic blood pressure <90 mmHg, Killip class ≥3, ventricular arrhythmia, cardiac arrest, or mechanical complications were excluded. A propensity-matched 12-month clinical outcome was compared between the groups and according to time to PCI.
In all patients and Propensity-matched cohort (n=1,131 in each group), group 1 had higher peak troponin level, a higher rate of pre-PCI Thrombolysis In Myocardial Infarction (TIMI) grade 0 or 1, higher use of glycoprotein IIb/IIIa inhibitor, and lower use of unfractionated heparin and nitrates. In all patients, 12-month rates of MI and death/MI were higher in group 1. No differences were observed in 12-month death and major adverse cardiac events (MACE: composite of death, MI, target vessel revascularization, and coronary artery bypass graft surgery). In the Propensity-matched cohort, non-significant differences were observed in 12-month rates of death, MI, death/MI or MACE. However, group 1 had less major bleeding (0.8% vs. 3.0%, p=0.024) and shorter hospital stay. In the propensity-matched cohort, the effect of PCI on 12-month outcome showed a U-shaped relationship with longer time to PCI: rates of MI and death/MI according to time to PCI (≤4 hours, 4-12 hours, 12-24 hours, 24-72 hours, >72 hours after arrival) were 2.7%, 1.3%, 1.1%, 1.9%, 2.2% and 6.5%, 4.2%, 3.9%, 5.2%, 6.1%, respectively. PCI 4-12 hours and 12-24 hours after arrival was associated with lower risk of 12-month MI (hazard ratio [HR]: 0.49, 95% confidence interval [CI]: 0.25 to 0.93, p=0.03 and HR: 0.40, 95% CI: 0.22 to 0.72, p=0.002) and death/MI (HR: 0.64, 95%CI: 0.44 to 0.93, p=0.02 and HR: 0.60, 95% CI: 0.43 to 0.84, p=0.003), respectively.
Immediate PCI for stable NSTEMI did not confer and advantage with respect to hard clinical endpoints at 12 months. PCI within 4-24 hours after arrival was associated with lower risk of adverse events.